Measles and measles-rubella vaccine support

Second dose of measles or measles-rubella vaccine introduced in 21 countries

132 million children reached through Gavi-supported measles catch-up campaigns

196 million children immunised through measles-rubella campaigns

In 2014 Tanzania launched a nationwide campaign to protect 21 million children against measles and rubella. Credit: Gavi/2014/Karel Prinsloo.

By the end of 2016, our support for a second dose of measles or measles-rubella vaccine had helped 21 countries immunise more than 40 million children. This support provides a second opportunity to reach children who missed the first dose. It also produces measles immunity in the small number of people who failed to develop it after the first dose.

In order to have a long-term impact on both measles and rubella control, we have invested more than US$ 600 million in large-scale measles-rubella catch-up campaigns since 2012. This catalytic support requires countries to introduce MR vaccines into their routine system after a campaign.

In the 2004–2008 period, Gavi funded measles mass campaigns in countries at high risk of outbreaks, including by providing US$ 176 million to the Measles Initiative (now called the Measles & Rubella Initiative) for measles campaigns. This support contributed to averting 860,000 future deaths.

Measles remains one of the top vaccine-preventable killers of children

Rubella infection in early pregnancy can result in foetal death or birth defects

Measles is a highly contagious virus and remains one of the top vaccine-preventable killers of children. Symptoms include high fever and a severe skin rash.

Thanks to the widespread introduction of measles vaccine, global measles deaths have fallen dramatically. Before 2001, more than 750,000 children died every year from measles. According to the WHO, global measles deaths fell by 79% between 2000 and 2015.

But even with this impressive decline, progress has stalled. Outbreaks continue across Africa and Europe, with more than 130,000 estimated deaths in 2015. Children under the age of five are most affected. More than 95% of measles deaths occur in low-income countries with weak health systems.

Rubella is no longer the threat it once was in many countries, thanks to widespread vaccination. But for millions of mothers and their children in developing countries, it poses an ongoing danger. When a woman is infected with the rubella virus early in pregnancy, she has a 90% risk of passing the virus on to her foetus. This can cause miscarriage, stillbirth or severe birth defects known as congenital rubella syndrome (CRS).

According to WHO, more than 100,000 babies are born with CRS each year. The majority are in Africa and South-East Asia. Although rubella vaccine has been available since the 1970s, it is still underused in these regions.

Gavi’s support for measles and rubella vaccines is a game changer in the control of two deadly and debilitating diseases

Students at a junior high school in Yogyakarta, Indonesia after receiving their measles-rubella vaccine shots. Credit: Gavi/2017/Ardiles Rante.

GAVI’S NEW MEASLES AND RUBELLA STRATEGY

Over the past five years, measles vaccine coverage has stagnated in Gavi-supported countries at around 78%. At the same time, the number of outbreaks has increased – both in developing and industrialised countries.

In December 2015, the Gavi Board approved a new strategy designed to reverse this trend and put countries back on track to control measles and rubella. Immunisation experts guiding the strategy rethink included representatives from WHO, UNICEF, the United States Centers for Disease Control and Prevention, and the Bill & Melinda Gates Foundation.

The new strategy came into effect in 2016. It focuses on increasing country ownership, strengthening routine immunisation, and ensuring long-term programmatic and financial sustainability. It also encourages better planned, more data-driven campaigns.

FOUR TYPES OF SUPPORT

Measles and measles-rubella routine immunisation

Gavi supports a second dose of measles vaccine and a first and/or second dose of measles-rubella vaccine. Countries contribute to the cost of these Gavi-supported vaccines by co-financing some of the required doses.

Supporting a second dose of the measles and rubella vaccine provides a second opportunity to reach children who missed the first dose. It also produces measles immunity in the small number of persons who failed to develop it after the first dose.

The new approach shifts our support for campaigns from focusing only on large at-risk countries to all Gavi-eligible countries that need it.

Measles-rubella catch-up campaigns

Gavi provides support for measles-rubella (MR) vaccine catch-up campaigns before the vaccine is introduced into the routine system. The campaigns target children aged 9 months to 14 years. By catalysing the vaccine’s introduction into the routine immunisation system, they help to ensure long-term impact on both measles and rubella control efforts.

Measles outbreak response (through the Measles & Rubella Initiative)

Gavi’s support for rubella is a game changer in the control of a disease that causes serious, life-long disabilities in infants.

Gavi provides US$ 55 million to the Measles & Rubella Initiative (M&RI, formerly the Measles Initiative) for the 2013–2017 period. The funding is used for outbreak response in Gavi-supported countries.

M&RI is a global partnership committed to ensuring no child dies from measles or is born with congenital rubella syndrome. It is led by the American Red Cross, the United Nations Foundation, the U.S. Centers for Disease Control and Prevention, UNICEF and WHO. The M&RI aims to achieve the measles and rubella elimination goals outlined in the Global Vaccine Action Plan.